Carly Michelle Funk, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4301 West Markham
Slot 584
Little Rock, AR 72205

Phone

(501) 686-6996

Fax

(501) 686-8586

NPI assigned

Mar 21, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1225898653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 WEST MARKHAM, SLOT 584, G184",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72205",
            "telephone_number": "501-526-7485",
            "fax_number": "501-686-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 WEST MARKHAM",
            "address_2": "SLOT 584",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72205",
            "telephone_number": "501-686-6996",
            "fax_number": "501-686-8586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1125 North College Avenue",
            "address_2": "Slot 100",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "72703",
            "country_code": "US",
            "telephone_number": "479-713-8310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Children's Way",
            "address_2": "Slot ACH 512-16",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "72202",
            "country_code": "US",
            "telephone_number": "501-364-2833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUNK",
        "first_name": "CARLY",
        "middle_name": "MICHELLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-21",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marshal Fuller, MNSC, APRN, AGACNP-B
• Paula Knod Fuller, CRNA
• William S Fuller, LCSW
• Fullerton Treatment Center
• Suzanne Lanay Fullerton, OTRL
• Adrianne R Funmaker, APRN
• Wade Fuqua
• Alexis Marquise Furlow
• Kirstin Danielle Furman, APRN
• Victoria N Furnary, PT

• Student in an Organized Health Care Education/Training Program in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Student in an Organized Health Care Education/Training Program in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.